Introduction
On inference from a range of randomised clinical trials, timely primary percutaneous coronary intervention (PPCI) has become the optimal strategy for the treatment of ST-segment elevation myocardial infarction (STEMI).1-8 Despite the logistic complexity and potential for delay compared with fibrinolytic treatment, the standard outcomes of safety and effectiveness of PPCI are superior to fibrinolysis unless the time delay is substantial.9-12 These data have led to the decision that, not only should PPCI be the treatment of choice for STEMI in England, it must be available 24 hours per day, seven days per week.13 This generates log

Introduction
Prompt primary percutaneous coronary intervention (PPCI) is the preferred treatment for patients presenting with ST-segment elevation myocardial infarction (STEMI).1 Clinical outcomes are better with higher procedural volume2 and the intuitive deduction is that PPCIs should be performed by high-volume, usually large, tertiary hospitals. Provision of 24-hour PPCIs by collaboration of other hospitals such as district general hospitals (DGHs) has not been studied in detail.
Sandwell General Hospital is an acute DGH that provides PPCI service without on-site cardiac surgical facilities to a catchment population of 250,000. The servic

As well as continuing the amazing level of care given to patients @RBandH on the paediatric ward every week, the Vocal Beats team @rbharts charitably funded to bring the arts to patients, staff and local community- will also be regularly visiting patients @royalmarsdenNHS Thanks!